Nursing process in the primary prevention of diabetes mellitus. What is the nursing process for diabetes? Basic principles of diet therapy

Since 1980, diabetes has been divided into 2 types (according to the WHO list):

• Type 1 - Insulin-dependent (mainly observed in children and young people).
• Type 2 - Insulin-independent (Usually found in adults and the elderly).

Nursing Process in diabetes mellitus is a set of evidence-based, and applied in practice, actions that a nurse performs as an aid to patients with this disease. The main goal of these actions is to ensure comfortable living during the period of illness by providing the most comfortable physical, psychological, social and spiritual state for the patient, taking into account his values.

Today, the nursing process has become one of the key terms in modern models of nursing. It is divided into several stages:

1. . Patient examination;
2. . Patient diagnosis;
3. . Patient Care Planning;
4. . Implementation of the care plan;
5. . Care impact assessment.

During the nursing process in a patient with diabetes, the nurse must, together with the sick person, form a specific plan of intervention. In order for the plan to be as effective as possible, it is necessary at the first assessment (examination of the patient) to find out all the important information about health and distinguish between part of the patient's needs for nursing care, as well as part of the medical activities that the patient can perform independently.

Main data sources:

1. . Conversation with the person being whitened and his relatives;
2. . Disease history;
3. . Information obtained at the time of the survey.

The nursing process for type 1 diabetes (as well as type 2) begins with the collection of information during the initial examination.

It is necessary to clarify with the patient:

1. . Does he / she follow the prescribed diet (No. 9 or physiological), which he / she follows the diet;
2. . Does he/she perform complex physical activities;

• Specify insulin therapy.

Determine the name of the insulin, the amount of medication used per day, the period of action, the treatment regimen.

• Specify the antidiabetic complex of treatment.

Determine which patient is taking additional drugs(except for insulin), in what doses, what are the features of the treatment, whether the patient tolerates them well.

• Refine analysis data.

When was the last time the patient donated blood / urine for glucose, what were the results, when was the last time he was seen by an endocrinologist.

• Information about the glucometer.

Does the patient know how to use it independently, the presence of a glucometer.

• Information about the table of bread units.

Whether he knows how to use it, he can make a menu for himself.

• Clarify the patient's knowledge of insulin.

Does the patient know how to use insulin medications, do injections correctly, knows where to inject insulin, does the patient know what to do in case of painful complications at the injection site.

It needs to be clarified:

1. . Has the sick person ever attended a Diabetes School?
2. . He had sometime cases of hypoglycemic and hyperglycemic coma. If so, what causes them and what symptoms accompanied them;
3. . Can the patient provide self-help;
4. . Does he have a “diabetic passport”;
5. . Is there a possibility of hereditary transmission of diabetes mellitus or predisposition to the disease;
6. . Are there additional diseases (diseases of the pancreas, gall, thyroid or other glands, obesity);
7. . What were the inconveniences during the inspection period.

The next stage of the nursing process is the examination of the patient, which consists in:

1. . Determination of color, skin moisture and the presence of wounds from scratching;
2. . Weighing body weight;
3. . Determination of pressure indicators;
4. . Measurement of pulse indicators on several arteries.

The nursing process for diabetes mellitus in the elderly should be carried out taking into account the fact that such patients most often belong to the second type of diabetes mellitus. However, in view of old age they should be treated more carefully and more carefully defined ways of nursing intervention. For example, you should give them several options for the daily menu to allow them to choose their own diet.

List of nursing interventions after examination (including assistance with the patient's family):

• 1. Conducting a conversation regarding the characteristics of nutrition, depending on the type of disease. Determine the diet.
• 2. Convince the diabetic of the need for strict adherence proper diet which is prescribed by the attending physician.
• 3. Encourage a diabetic to regularly exercise as prescribed by a doctor.
• 4. Consult the patient about the essence of the disease, possible reasons and expected complications.
• 5. Advise the patient about insulin therapy (what are the types, how long does the drug work, how to combine it with food, how should it be stored, what are the side effects, types of insulin needles and how to use them).
• 6. Control the correct administration of insulin, as well as other antidiabetic agents.
• 7. Test skin, pulse, weight, blood pressure, glucose levels in tests and follow the doctor's recommendations.

Nursing process for diabetes mellitus in children should be carried out taking into account the insulin-dependent type. this disease. Quite often, a small patient is diagnosed during a period of diabetic coma. The prognosis of recovery is directly related to timely treatment.

The nurse must check:

1. . The presence of constant physical activity;
2. . Compliance with diet No. 9;
3. . Conducting insulin replacement therapy, taking into account an individually selected dose;
4. . Teach your child how to live with diabetes and ways of self-control.

Nursing process in diabetes mellitus. Diabetes mellitus is a chronic disease characterized by a violation of the production or action of insulin and leads to a violation of all types of metabolism and, first of all, carbohydrate metabolism. Classification of diabetes mellitus adopted by WHO in 1980:
1. Insulin-dependent type - type 1.
2. Insulin-independent type - type 2.
Type 1 diabetes is more common in young people, type 2 diabetes is more common in middle-aged and elderly people.
In diabetes, the causes and risk factors are so closely intertwined that it is sometimes difficult to separate them. One of the main risk factors is hereditary predisposition (type 2 diabetes mellitus is hereditarily more unfavorable), obesity, unbalanced nutrition, stress, pancreatic diseases, and toxic substances also play an important role. in particular alcohol, diseases of other endocrine organs.
Stages of diabetes:
Stage 1 - prediabetes - a state of predisposition to diabetes mellitus.
Risk group:
- Persons with burdened heredity.
- Women who gave birth to a live or dead child weighing more than 4.5 kg.
- Persons suffering from obesity and atherosclerosis.
Stage 2 - latent diabetes - is asymptomatic, the fasting glucose level is normal - 3.3-5.5 mmol / l (according to some authors - up to 6.6 mmol / l). Latent diabetes can be detected by a glucose tolerance test, when a patient, after taking 50 g of glucose dissolved in 200 ml of water, has an increase in blood sugar: after 1 hour, above 9.99 mmol / l. and after 2 hours - more than 7.15 mmol / l.
Stage 3 - obvious diabetes - the following symptoms are characteristic: thirst, polyuria, increased appetite, weight loss, pruritus (especially in the perineum), weakness, fatigue. In the blood test, an increased content of glucose, it is also possible to excrete glucose in the urine.
With the development of complications associated with damage to the vessels of the central nervous system. eye fundus. kidneys, heart, lower extremities, symptoms of damage to the corresponding organs and systems join.

Nursing process in diabetes mellitus:
Patient problems:
A. Existing (real):
- thirst;
- polyuria:
- skin itching. dry skin:
- increased appetite;
- weight loss;
- weakness, fatigue; decreased visual acuity;
- heartache;
- pain in the lower extremities;
- the need to constantly follow a diet;
- the need for constant administration of insulin or taking antidiabetic drugs (maninil, diabeton, amaryl, etc.);
Lack of knowledge about:
- nature of the disease and its causes;
- diet therapy;
- self-help for hypoglycemia;
- foot care;
- Calculation of bread units and menu preparation;
- using a glucometer;
- complications of diabetes mellitus (coma and diabetic angiopathy) and self-help in coma.
B. Potential:
Development risk:
- precomatous and comatose conditions:
- gangrene of the lower extremities;
- acute myocardial infarction;
- chronic kidney failure;
- cataracts and diabetic retinopathy with visual impairment;
- secondary infections, pustular skin diseases;
- complications due to insulin therapy;
- slow healing of wounds, including postoperative ones.
Collection of information during the initial examination:
Questioning the patient about:
- following a diet (physiological or diet No. 9), about the diet;
- physical activity during the day;
- ongoing treatment:
- insulin therapy (name of insulin, dose, duration of its action, treatment regimen);
- antidiabetic tablet preparations (name, dose, features of their administration, tolerability);
- prescription of blood and urine tests for glucose content and examination by an endocrinologist;
- the patient has a glucometer, the ability to use it;
- the ability to use the table of bread units and make a menu for bread units;
- the ability to use an insulin syringe and a syringe pen;
- knowledge of the places and techniques of insulin administration, prevention of complications (hypoglycemia and lipodystrophy at injection sites);
- keeping a diary of observations of a patient with diabetes mellitus:
- visiting in the past and at present "School of the diabetic";
- development in the past of hypoglycemic and hyperglycemic coma, their causes and symptoms;
- ability to provide self-help;
- if the patient has a Diabetic Passport or a Diabetic Visiting Card;
- hereditary predisposition to diabetes);
- concomitant diseases (diseases of the pancreas, other endocrine organs, obesity);
- Patient's complaints at the time of examination.
Patient examination:
- color, humidity skin, the presence of combs:
- determination of body weight:
- measurement of blood pressure;
- determination of the pulse on the radial artery and on the artery of the rear of the foot.
Nursing interventions, including work with the patient's family:
1. Conduct a conversation with the patient and his relatives about the peculiarities of nutrition, depending on the type of diabetes mellitus, diet. For a patient with type 2 diabetes, give several samples of the menu for the day.
2. Convince the patient of the need to follow the diet prescribed by the doctor.
3. Convince the patient of the need for physical activity recommended by the doctor.
4. Have a conversation about the causes, essence of the disease and its complications.
5. Inform the patient about insulin therapy (types of insulin, onset and duration of its action, connection with food intake, storage features, side effects, types of insulin syringes and syringe pens).
6. Ensure timely administration of insulin and antidiabetic drugs.
7. Control:
- the condition of the skin;
- body weight:
- pulse and arterial pressure;
- pulse on the artery of the rear of the foot;
- adherence to diet and diet; transmission to the patient from his relatives;
- recommend constant monitoring of glucose in the blood and urine.
8. Convince the patient of the need for constant monitoring by an endocrinologist, keeping an observation diary, which indicates indicators of glucose levels in blood, urine, blood pressure levels, foods eaten per day, therapy received, changes in well-being.
9. Recommend periodic examinations by an ophthalmologist, surgeon, cardiologist, nephrologist.
10. Recommend classes at the Diabetes School.
11. Inform the patient about the causes and symptoms of hypoglycemia, coma.
12. Convince the patient of the need for a slight deterioration in health and blood counts to immediately contact an endocrinologist.
13. Educate the patient and his relatives:
- calculation of grain units;
- compiling a menu according to the number of bread units per day; recruitment and subcutaneous injection insulin with an insulin syringe;
- rules for foot care;
- provide self-help for hypoglycemia;
- measurement of blood pressure.
Emergency conditions in diabetes mellitus:
BUT. hypoglycemic state. Hypoglycemic coma.
The reasons:
- Overdose of insulin or antidiabetic tablets.
- Lack of carbohydrates in the diet.
- Insufficient food intake or skipping meals after insulin administration.
- Significant physical activity.
Hypoglycemic states are manifested by a feeling of severe hunger, sweating, trembling of the limbs, severe weakness. If this condition is not stopped, then the symptoms of hypoglycemia will increase: trembling will increase, confusion in thoughts, headache, dizziness, double vision, general anxiety, fear, aggressive behavior and the patient will fall into a coma with loss of consciousness and convulsions.
Symptoms of hypoglycemic coma: the patient is unconscious, pale, there is no smell of acetone from the mouth. moist skin, profuse cold sweat, increased muscle tone, free breathing. arterial pressure and pulse are not changed, the tone of the eyeballs is not changed. In the blood test, the sugar level is below 3.3 mmol / l. there is no sugar in the urine.
Self-help for hypoglycemic condition:
It is recommended that at the first symptoms of hypoglycemia, eat 4-5 pieces of sugar, or drink warm sweet tea, or take 10 glucose tablets of 0.1 g, or drink from 2-3 ampoules of 40% glucose, or eat a few sweets (preferably caramel ).
First aid in a hypoglycemic state:
- Call a doctor.
- Call the laboratory assistant.
- Place the patient in a stable lateral position.
- Place 2 pieces of sugar behind the cheek on which the patient is lying.
Prepare medicines:
40 and 5% glucose solution. 0.9% sodium chloride solution, prednisolone (amp.), hydrocortisone (amp.), glucagon (amp.).
B. Hyperglycemic (diabetic, ketoacidotic) coma.
The reasons:
- Insufficient dose of insulin.
- Violation of the diet (high content of carbohydrates in food).
- Infectious diseases.
- Stress.
- Pregnancy.
- Injuries.
- Surgical intervention.
Harbingers: increased thirst, polyuria. possible vomiting, loss of appetite, blurred vision, unusually severe drowsiness, irritability.
Symptoms of a coma: consciousness is absent, the smell of acetone from the mouth, hyperemia and dryness of the skin, noisy deep breathing, decreased muscle tone- "soft" eyeballs. Pulse is thready, arterial pressure is lowered. In the analysis of blood - hyperglycemia, in the analysis of urine - glucosuria, ketone bodies and acetone.
With the appearance of harbingers of coma, urgently contact an endocrinologist or call him at home. With signs of hyperglycemic coma, an urgent call emergency care.
First aid:
- Call a doctor.
- Give the patient a stable lateral position (prevention of retraction of the tongue, aspiration, asphyxia).
- Take urine with a catheter for express diagnostics of sugar and acetone.
- Provide intravenous access.
Prepare medicines:
- short-acting insulin - actropid (vial);
- 0.9% sodium chloride solution (vial); 5% glucose solution (vial);
- cardiac glycosides, vascular agents.

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State Autonomous Education Institution

Medium vocational education Saratov region

Saratov Regional Basic Medical College

subject: Nursing process in therapy

on the topic: nursing care with diabetes

Performed:

Karmanova Galina Maratovna

Saratov 2015

Introduction

1. Diabetes

2. Etiology

3. Pathogenesis

4. Clinical signs.

5. Types of diabetes

6. Treatment

7. Complications

11 Observation #1

12. Observation #2

Conclusion

Bibliography

Application

Introduction

Diabetes mellitus (DM) is an endocrine disease characterized by a syndrome of chronic hyperglycemia, which is the result of insufficient production or action of insulin, which leads to disruption of all types of metabolism, primarily carbohydrate, vascular damage (angiopathy), nervous system(neuropathy), as well as other organs and systems. At the turn of the century, diabetes mellitus (DM) became epidemic, being one of the most common causes disability and mortality. It is included in the first triad in the structure of diseases of the adult population: cancer, sclerosis, diabetes. Among the heavy chronic diseases in children, diabetes mellitus also ranks third, behind the palm bronchial asthma and children's cerebral palsy. The number of patients with diabetes worldwide is 120 million (2.5% of the population). Every 10-15 years the number of patients doubles. According to the International Diabetes Institute (Australia), by 2010 there will be 220 million patients in the world. There are about 1 million patients in Ukraine, of which 10-15% suffer from the most severe insulin-dependent diabetes (type I). In reality, the number of patients is 2-3 times higher due to hidden undiagnosed forms. Basically, this refers to type II diabetes, which accounts for 85-90 of all cases of diabetes.

Subject of study: Nursing process in diabetes mellitus.

Object of study: Nursing process in diabetes mellitus.

The purpose of the study: To study the nursing process in diabetes mellitus. diabetes nursing care

To achieve this goal, research needs to be explored.

Etiology and contributing factors of diabetes mellitus.

Pathogenesis and its complications

· Clinical signs of diabetes in which it is customary to distinguish between two groups of symptoms: major and minor.

Types of diabetes

complication

Manipulations performed by a nurse

Prevention

· Treatment

Forecast

To achieve this goal of the study, it is necessary to analyze:

Describing tactics nurse in the implementation of the nursing process in a patient with this disease.

Research methods:

The following methods are used for the study.

Scientific and theoretical analysis of medical literature on diabetes mellitus

Biographical (study of medical records)

Practical significance.

Detailed disclosure of material on the topic term paper: "Nursing process in diabetes mellitus" will improve the quality of nursing care.

1. Diabetes

A bit of history.

Diabetes mellitus was known in Ancient Egypt as early as 170 BC. Doctors tried to find ways to treat, but they did not know the cause of the disease; and people with diabetes mellitus were doomed to death. This went on for many centuries. Only at the end of the last century, doctors conducted an experiment to remove the pancreas from a dog. After the operation, the animal developed diabetes mellitus. It seemed that the cause of diabetes became clear, but many more years passed before, in 1921, in the city of Toronto, a young doctor and medical student isolated a special substance from the pancreas of a dog. It turned out that this substance reduces blood sugar levels in dogs with diabetes. This substance was called insulin. Already in January 1922, the first patient with diabetes began to receive insulin injections, and this saved his life. Two years after the discovery of insulin, a young doctor from Portugal who treated patients with diabetes thought about the fact that diabetes is not just a disease, but a very special way of life. To learn it, the patient needs solid knowledge about his disease. Then the world's first school for patients with diabetes appeared. Now there are many such schools. Around the world, patients with diabetes and their families have the opportunity to learn about the disease, and this helps them to be full members of society.

Diabetes is a disease for life. The patient has to constantly show perseverance and self-discipline, and this can psychologically break anyone. Perseverance, humanity, cautious optimism are also needed in the treatment and care of patients with diabetes mellitus; otherwise, it will not be possible to help the sick overcome all the obstacles in their life path. Diabetes mellitus occurs either when there is a deficiency or a violation of the action of insulin. In both cases, the concentration of glucose in the blood increases (hyperglycemia develops), combined with many other metabolic disorders: for example, with a pronounced deficiency of insulin in the blood, the concentration of ketone bodies increases. Diabetes mellitus in all cases is diagnosed only by the results of determining the concentration of glucose in the blood in a certified laboratory.

Normal glucose tolerance test clinical practice, as a rule, are not used, but are carried out only with a doubtful diagnosis in young patients or to verify the diagnosis in pregnant women. To obtain reliable results, a glucose tolerance test should be performed in the morning on an empty stomach; the patient should sit quietly during blood sampling, he is forbidden to smoke; within 3 days before the test, he must follow the usual, and not without carbohydrate diet. During the period of convalescence after diseases and with prolonged bed rest, the results of the test may be false. The test is carried out as follows: on an empty stomach, they measure the level of glucose in the blood, give the subject inside 75 g of glucose dissolved in 250-300 ml of water (for children, 1.75 g per 1 kg of weight, but not more than 75 g; for a more pleasant taste can be added, for example, natural lemon juice), and repeat the measurement of blood glucose levels after 1 or 2 hours. Urinalysis is collected three times - before taking the glucose solution, after 1 hour and 2 hours after ingestion. A glucose tolerance test also reveals:

1. Renal glucosuria - the development of glucosuria against the background normal level blood glucose; this condition is usually benign and is rarely due to kidney disease. It is desirable for patients to issue a certificate of the presence of renal glucosuria so that they do not have to re-test for glucose tolerance after each urine test in other medical institutions;

2. Pyramidal curve of glucose concentration - a condition in which the level of glucose in the blood on an empty stomach and 2 hours after taking a glucose solution is normal, but hyperglycemia develops between these values, causing glucosuria. This condition is also considered benign; most often it occurs after gastrectomy, but can also be observed in healthy people. The need for treatment in case of impaired glucose tolerance is determined by the doctor individually. Usually, elderly patients are not treated, and younger ones are recommended a diet, physical exercises and weight loss. In almost half of the cases, impaired glucose tolerance leads to diabetes mellitus within 10 years, in a quarter it persists without deterioration, in a quarter it disappears. Pregnant women with impaired glucose tolerance are treated similarly to the treatment of diabetes mellitus.

2. Etiology

Currently, it is considered a proven genetic predisposition to diabetes mellitus. For the first time, such a hypothesis was expressed in 1896, at that time it was confirmed only by the results of statistical observations. In 1974, J. Nerup and co-authors, A. G. Gudworth and J. C. Woodrow, found a relationship between the B-locus of leukocyte histocompatibility antigens and type 1 diabetes and their absence in individuals with type 2 diabetes. Subsequently, a number of genetic variations were identified that occur much more often in the genome of diabetic patients than in the rest of the population. So, for example, the presence of both B8 and B15 in the genome increased the risk of the disease by approximately 10 times. The presence of Dw3/DRw4 markers increases the risk of the disease by 9.4 times. About 1.5% of cases of diabetes are associated with the A3243G mutation of the mitochondrial MT-TL1 gene. However, it should be noted that in type 1 diabetes, genetic heterogeneity is observed, that is, the disease can be caused by different groups of genes. A laboratory diagnostic sign that allows you to determine type 1 diabetes is the detection of antibodies to pancreatic β-cells in the blood. The nature of inheritance is currently not entirely clear, the difficulty of predicting inheritance is associated with the genetic heterogeneity of diabetes mellitus, and the construction of an adequate inheritance model requires additional statistical and genetic studies.

3. Pathogenesis

There are two main links in the pathogenesis of diabetes mellitus:

Insufficient production of insulin by the endocrine cells of the pancreas;

Violation of the interaction of insulin with cells of body tissues (insulin resistance) as a result of a change in the structure or a decrease in the number of specific receptors for insulin, a change in the structure of insulin itself, or a violation of the intracellular mechanisms of signal transmission from receptors to cell organelles.

There is a hereditary predisposition to diabetes. If one of the parents is sick, then the probability of inheriting type 1 diabetes is 10%, and type 2 diabetes is 80%.

pathogenesis of complications.

Regardless of the mechanisms of development, a common feature of all types of diabetes is a persistent increase in blood glucose levels and impaired metabolism of body tissues that are no longer able to absorb glucose.

The inability of tissues to use glucose leads to increased catabolism of fats and proteins with the development of ketoacidosis.

An increase in the concentration of glucose in the blood leads to an increase in the osmotic pressure of the blood, which causes a serious loss of water and electrolytes in the urine.

A persistent increase in blood glucose concentration negatively affects the condition of many organs and tissues, which ultimately leads to the development of severe complications, such as diabetic nephropathy, neuropathy, ophthalmopathy, micro- and macroangiopathy, different kinds diabetic coma and others.

Decreased reactivity in diabetic patients immune system and severe infectious diseases.

Diabetes mellitus, like, for example, hypertension, is a genetically, pathophysiologically, clinically heterogeneous disease.

4. Clinical signs

The main complaints of patients are:

Severe general and muscle weakness,

dry mouth,

Frequent and profuse urination both day and night

Weight loss (typical for patients with type 1 diabetes),

Increased appetite (with severe decompensation of the disease, appetite is sharply reduced),

Itching of the skin (especially in the genital area in women).

These complaints usually appear gradually, however, type 1 diabetes symptoms of the disease can appear quite quickly. In addition, patients present with a number of complaints due to lesions internal organs, nervous and vascular systems.

Skin and muscular system

In the period of decompensation, dry skin, a decrease in its turgor and elasticity are characteristic. Patients often have pustular skin lesions, recurrent furunculosis, hidradenitis. Fungal lesions of the skin (epidermophytosis of the feet) are very characteristic. As a result of hyperlipidemia, xanthomatosis of the skin develops. Xanthomas are yellowish papules and nodules filled with lipids, located in the buttocks, legs, knees and elbow joints, forearms.

In 0.1 - 0.3% of patients, lipoid necrobiosis of the skin is observed. It is localized mainly on the legs (one or both). Initially, dense reddish-brown or yellowish nodules or spots appear, surrounded by an erythematous border of dilated capillaries. Then the skin over these areas gradually atrophies, becomes smooth, shiny with pronounced lichenification (reminiscent of parchment). Sometimes the affected areas ulcerate, heal very slowly, leaving behind pigmented areas. Nail changes are often observed, they become brittle, dull, a yellowish color appears.

Type 1 diabetes is characterized by significant weight loss, pronounced muscle atrophy, and a decrease in muscle mass.

The digestive system.

The most typical changes are:

Progressive caries,

Periodontal disease, loosening and tooth loss,

Gingivitis, stomatitis,

Chronic gastritis, duodenitis with a gradual decrease in the secretory function of the stomach (due to a deficiency of insulin, a stimulant of gastric secretion),

Decrease motor function stomach,

Intestinal dysfunction, diarrhea, steatorrhea (due to a decrease in the external secretory function of the pancreas),

· Fatty hypotheses (diabetic hypatopathy) develops in 80% of patients with diabetes; characteristic manifestations are an increase in the liver and its slight soreness,

· Chronic cholecystitis,

Dyskinesia of the gallbladder.

The cardiovascular system.

DM promotes excessive synthesis of atherogenic lipoproteins and more early development atherosclerosis and ischemic heart disease. IHD in patients with DM develops earlier and is more severe and more often gives complications.

diabetic cardiopathy.

"Diabetic heart" is a dysmetabolic myocardial dystrophy in diabetic patients under the age of 40 without distinct signs of coronary atherosclerosis. Main clinical manifestations diabetic cardiopathy are:

Slight shortness of breath physical activity, sometimes palpitations and interruptions in the region of the heart,

· ECG changes,

Miscellaneous violations heart rate and conductivity

Hypodynamic syndrome, manifested in a decrease in the stroke volume of blood in the left ventricle,

Decreased tolerance to physical activity.

Respiratory system.

Patients with diabetes are predisposed to pulmonary tuberculosis. Microangiopathy of the lungs is characteristic, which creates prerequisites for frequent pneumonia. Patients with diabetes also often suffer from acute bronchitis.

urinary system.

With diabetes, infectious diseases often develop - inflammatory disease urinary tract, which proceed in the following forms:

Asymptomatic urinary infection

Latently flowing pyelonephritis,

· Acute pyelonephritis,

Acute suppuration of the kidney,

Severe hemorrhagic cystitis.

According to the state of carbohydrate metabolism, the following phases of DM are distinguished:

Compensation - such a course of diabetes when, under the influence of treatment, normoglycemia and aglucosuria are achieved,

Subcompensation - moderate hyperglycemia (not more than 13.9 mmol / l), glucosuria, not exceeding 50 g per day, the absence of acetonuria,

Decompensation - blood glycemia more than 13.9 mmol / l, the presence of varying degrees acetonuria

5. Types of diabetes

Type I diabetes mellitus:

Type I diabetes mellitus develops when the β-cells of the pancreatic islets (islets of Langerhans) are destroyed, causing a decrease in insulin production. The destruction of β-cells is caused by an autoimmune reaction associated with the combined action of factors environment and hereditary factors in genetically predisposed individuals. Such a complex nature of the development of the disease can explain why among identical twins type I diabetes develops only in approximately 30% of cases, and type II diabetes in almost 100% of cases. It is believed that the process of destruction of the islets of Langerhans begins at a very early age, several years before the development of clinical manifestations of diabetes mellitus.

State of the HLA system.

Major histocompatibility complex antigens (HLA system) determine a person's predisposition to different types immunological reactions. In type I diabetes mellitus, DR3 and/or DR4 antigens are detected in 90% of cases; DR2 antigen prevents the development of diabetes mellitus.

Autoantibodies and cellular immunity.

In most cases, at the time of detection of type 1 diabetes, patients have antibodies to the cells of the islets of Langerhans, the level of which gradually decreases, and after a few years they disappear. Recently, antibodies have also been found against certain proteins - glutamic acid decarboxylase (GAD, 64-kDa antigen) and tyrosine phosphatase (37 kDa, IA-2; even more often associated with the development of diabetes). The detection of antibodies> 3 types (to cells of the islets of Langerhans, anti-GAD, anti-1A-2, to insulin) in the absence of diabetes mellitus is accompanied by an 88% risk of developing it in the next 10 years. Inflammatory cells (cytotoxic T-lymphocytes and macrophages) destroy β-cells, as a result of which insulitis develops in the early stages of type 1 diabetes. The activation of lymphocytes is due to the production of cytokines by macrophages. In studies to prevent the development of type I diabetes mellitus, immunosuppression with cyclosporine helps to partially preserve the function of the islets of Langerhans; however, it is accompanied by numerous side effects and does not provide complete suppression of process activity. The effectiveness of the prevention of type I diabetes mellitus with nicotinamide, which suppresses the activity of macrophages, has also not been proven. In part, the preservation of the function of the cells of the islets of Langerhans is facilitated by the introduction of insulin; clinical trials are currently underway to evaluate the effectiveness of the treatment.

Type II diabetes

There are many reasons for the development of type II diabetes mellitus, since this term is understood as a wide range of diseases with different course patterns and clinical manifestations. They are united by a common pathogenesis: a decrease in insulin secretion (due to impaired function of the islets of Langerhans in combination with an increase in peripheral insulin resistance, which leads to a decrease in glucose uptake by peripheral tissues) or an increase in glucose production by the liver. In 98% of cases, the cause of the development of type II diabetes cannot be determined - in this case, they speak of "idiopathic" diabetes. Which of the lesions (reduced insulin secretion or insulin resistance) is primary is unknown; Possibly, the pathogenesis is different in different patients. Most often, insulin resistance is due to obesity; rarer causes of insulin resistance. In some cases, patients older than 25 years (especially in the absence of obesity) develop not type II diabetes mellitus, but latent autoimmune diabetes of adults LADA (Latent Autoimmune Diabetes of Adulthood), which becomes insulin dependent; in this case, specific antibodies are often detected. Type II diabetes progresses slowly: insulin secretion gradually decreases over several decades, imperceptibly leading to an increase in glycemia, which is extremely difficult to normalize.

In obesity, relative insulin resistance occurs, probably due to the suppression of insulin receptor expression due to hyperinsulinemia. Obesity significantly increases the risk of type II diabetes mellitus, especially in android fat distribution (visceral obesity; apple-shaped obesity; waist circumference to bede ratio > 0.9) and to a lesser extent in gynoid fat distribution ( pear-shaped obesity; waist-to-hip ratio< 0,7). На формирование образа жизни, способствующего ожирению, может влиять лептин -- одноцепочечный пептид, вырабатываемый жировой тканью; a large number of There are leptin receptors in the brain and peripheral tissues. Administration of leptin to leptin-deficient rodents causes severe hypophagia and weight loss. The level of leptin in plasma increases in proportion to the content of adipose tissue in the body. Several isolated cases of the development of obesity caused by leptin deficiency and successfully treated with its administration have been described, however, in most cases, the administration of leptin does not have a noticeable biological effect, therefore, it is not used in the treatment of obesity.

Risk factors for developing type II diabetes:

* Age over 40 years.

* Mongoloid, Negroid, Hispanic origin.

* Overweight.

* Diabetes mellitus type II in relatives.

* For women: history of gestational diabetes.

* Birth weight > 4 kg.

It has recently been shown that low birth weight is associated with the development of insulin resistance, type II diabetes, in adulthood. coronary disease hearts. The lower the birth weight and the more it exceeds the norm at the age of 1 year, the higher the risk. In the development of type II diabetes mellitus, hereditary factors play a very important role, which is manifested by a high frequency of its simultaneous development in identical twins, a high frequency of family cases of the disease, and a high incidence in some nationalities. Researchers are identifying more and more new genetic defects that cause Type II diabetes; some of them are described below.

Type II diabetes mellitus in children has been described only in some minority populations and in rare congenital MODY syndromes (see below). Currently, in industrialized countries, the incidence of type II diabetes mellitus in children has increased significantly: in the United States, it accounts for 8-45% of all cases of diabetes in children and adolescents, and continues to grow. Most often, adolescents aged 12-14 years old, mostly girls, get sick; as a rule, against the background of obesity, low physical activity and the presence of type II diabetes mellitus in a family history. In young non-obese patients, LADA type diabetes is first ruled out, which must be treated with insulin. In addition, nearly 25% of type II diabetes at a young age is due to a genetic defect in MODY or other rare syndromes. Diabetes can also be caused by insulin resistance. In some rare forms of insulin resistance, hundreds or even thousands of units of insulin are ineffective. Such conditions are usually accompanied by lipodystrophy, hyperlipidemia, acanthosis nigricans. Type A insulin resistance is due to genetic defects in the insulin receptor or post-receptor intracellular signal transduction mechanisms. Type B insulin resistance is due to the production of autoantibodies to insulin receptors; often combined with other autoimmune diseases, such as systemic lupus erythematosus (especially in black women). These types of diabetes are very difficult to treat.

MODY-diabetes.

This disease is a heterogeneous group of autosomal dominant diseases caused by genetic defects that lead to a deterioration in the secretory function of pancreatic β-cells. MODY diabetes occurs in approximately 5% of diabetic patients. It starts at a relatively early age. The patient needs insulin, but, unlike patients with type 1 diabetes, has a low insulin requirement, successfully achieves compensation. The C-peptide values ​​correspond to the norm, there is no ketoacidosis. This disease can be conditionally attributed to the "intermediate" types of diabetes: it has features characteristic of type 1 and type 2 diabetes.

6. Treatment of diabetes

The main principles of the treatment of DM are:

2) Individual physical activity,

3) Sugar-reducing drugs:

A) insulin

B) tableted sugar-reducing drugs,

4) Education of patients in "diabetes schools".

Diet. Diet is the foundation on which life is based complex therapy patients with diabetes. Approaches to diet in type 1 and type 2 diabetes are fundamentally different. With DM 2, we are talking about diet therapy, the main goal of which is to normalize body weight, which is the basic provision for the treatment of DM 2. With DM 1, the question is put differently: the diet in this case is a forced restriction associated with the impossibility of accurately imitating the physiological secretion of insulin . Thus, this is not dietary treatment, as in the case of type 2 diabetes, but a diet and lifestyle that contributes to maintaining optimal diabetes compensation. Ideally, the diet of a patient on intensive insulin therapy seems to be completely liberalized, i.e. he eats like healthy man(what he wants, when he wants, how much he wants). The only difference is that he injects himself with insulin, masterfully mastering the selection of the dose. Like any ideal, complete liberalization of the diet is impossible and the patient is forced to comply with certain restrictions. The ratio of proteins, fats and carbohydrates recommended for patients with diabetes => 50%:<35%:15%.

Indications for insulin therapy:

ketoacidosis, precoma, coma;

decompensation of diabetes due to various factors (stress, infection, trauma, surgery, exacerbation of somatic diseases);

diabetic nephropathy with impaired nitrogen excretion of the kidneys, severe liver damage, pregnancy and childbirth, type 1 diabetes mellitus, severe dystrophic skin lesions, significant depletion of the patient, lack of effect from diet therapy and oral hypoglycemic agents, severe surgical interventions, especially abdominal ones; a long-term inflammatory process in any organ (pulmonary tuberculosis, pyelonephritis, etc.).

insulins

Types of insulin: porcine, human.

Closest to human porcine insulin, it differs from human only in one amino acid.

According to the degree of purification: monocomponent insulins are currently produced.

By duration:

1) ultra-short action (duration of action 4 hours) -

b humalog,

b Novorapid;

2) fast but short-acting insulins (onset of action after 15-30 minutes, duration 5-6 hours) - actrapid NM, MS,

b humulin R,

b insuman-normal;

3) insulins of medium duration of action (the onset of action after 3-4 hours, the end after 14-16 hours) -

b humulin NPH;

b protafan NMK;

b monotard MS, NM;

b brinsulmidi Ch;

b insuman basal;

4) ultra-long-acting insulins (the onset of action after 6-8 hours, the end after 24-26 hours) - ultralong, ultralente, ultratard NM, lantus (peakless, “ribbon” insulin);

5) pre-mixed (in these insulins, short and long insulins are mixed in a certain proportion: humulin M1, M2, M3 (the most common), M4; combined insuman.

Insulin regimens:

The mode of two-fold injection of insulin (insulin mixtures). Convenient for students and working patients. In the morning and evening (before breakfast and dinner), short-acting insulins are administered in combination with medium- or long-acting insulins. At the same time, 2/3 of the total daily dose is administered in the morning and 1/3 in the evening; 1/3 of each calculated dose is short-acting insulin, and 2/3 is prolonged; the daily dose is calculated on the basis of 0.7 IU, with newly diagnosed diabetes - 0.5 IU) per 1 kg of theoretical weight.

By injecting insulin daily.

The second injection of intermediate-acting insulin from dinner is transferred to the night (at 21 or 22 hours), as well as with a high level of glycemia on an empty stomach (at 6-8 in the morning).

Intensive basic - balus therapy is considered the most optimal. In this case, long-acting insulin is administered before breakfast at a dose equal to 1/3 of the daily dose; the remaining 2/3 of the daily dose is administered in the form of short-acting insulin (it is distributed before breakfast, lunch and dinner in a ratio of 3:2:1).

The method for calculating the doses of short insulin depending on the XE ...

Bread unit (XE) is the equivalent of replacing carbohydrate-containing products by their content of 10-12g of carbohydrates. 1 XE increases blood sugar by 1.8-2 mmol / l and requires the introduction of 1-1.5 units of insulin. Short-acting insulin is prescribed before breakfast at a dose of 2 IU per 1 XE, before lunch - 1.5 IU of insulin per 1 XE, before dinner - 1.2 IU of insulin per 1 XE. For example, 1 XE is contained in 1 slice of bread, 1.5 tbsp. pasta, in 2 tbsp. any cereal, in 1 apple, etc.

A prerequisite in the treatment of type 1 diabetes is diet.

Meals according to table N 9 with restriction of easily digestible carbohydrates. The calculation of food is carried out taking into account 30-35 kcal per 1 kg of body weight, although it must be remembered that the diet for type 2 diabetes should be stricter. Individual physical activity is recommended, which is contraindicated for glycemia of more than 15 mmol / l. To simplify and facilitate insulin injections, syringes - pens "Novopen", "Optipen" are now used. Syringes - pens are equipped with an insulin cartridge with a concentration of 100 IU / ml, the capacity of the cartridges is 1.5 and 3 ml.

Treatment of type 2 diabetes.

At the first stage, a diet is prescribed, which should be hypocaloric, contributing to weight loss in obese patients. In case of ineffectiveness of diet therapy, oral agents are added to the treatment. One of the main tasks in diabetology is the fight against postprandial hyperglycemia.

Sugar-reducing drugs are divided into secretogogues:

I. Ultra-short action:

II. A. group of glinides - Novonorm, Starlex 60 and 120 mg,

B. Hypoglycemic sulfonamides:

regular (medium) action: maninil, daonil, euglicon 5mg, diabetone 80mg, predian, reclid 80mg, glurenorm 30mg, glipizide 5mg;

daily action: diabetone MB, amaryl, glutrol XL

II. Insulin sensitizers:

A. Glitazones - rosiglitazone, troglitazone, englitazone, pioglitazone, actos, aventia;

B. Biguanides - Metformin (Siofor 500mg, 850mg)

III. drugs that inhibit the absorption of carbohydrates.

A. Inhibitors of a - glucosidase (acarbose).

B. Short-acting secretagogues act on K-ATP channels, selectively act in hyperglycemia. Act on the 1st phase of insulin secretion. Biguanides increase the utilization of glucose by peripheral tissues, reduce the production of glycogen in the liver, have an antihyperglycemic effect, and reduce blood pressure. Indications: Type 2 diabetes combined with obesity and hyperlipidemia, IGT+ obesity, obesity without diabetes.

B. Glibomet is the only drug that affects 3 pathological links (glibenclamide 2.5 mg + metformin 400 mg).

Combination Therapy:

b secretogogues + biguanides,

b secretogogues + glitazones,

b secretogogues + drugs that reduce glucose absorption.

It should be recognized that 40% of patients with type 2 diabetes receive insulin, i. DM 2 is "insulin-requiring". Experience shows that after 5-7 years, patients with type 2 diabetes become resistant to oral therapy and have to be switched to insulin.

7. Complication

Acute complications are conditions that develop over days or even hours in the presence of diabetes.

Diabetic ketoacidosis is a serious condition that develops as a result of the accumulation in the blood of products of intermediate metabolism of fats (ketone bodies). It occurs with concomitant diseases, primarily infections, injuries, operations, and malnutrition. It can lead to loss of consciousness and disruption of vital body functions. It is a vital indication for urgent hospitalization.

Hypoglycemia - a decrease in blood glucose levels below the normal value (usually below 3.3 mmol / l), occurs due to an overdose of hypoglycemic drugs, concomitant diseases, unusual physical activity or malnutrition, drinking strong alcohol. First aid consists in giving the patient a solution of sugar or any sweet drink inside, eating food rich in carbohydrates (sugar or honey can be kept under the tongue for faster absorption), if possible, injecting glucagon preparations into the muscle, injecting 40% glucose solution into the vein (before Vitamin B1 should be injected subcutaneously with the introduction of a 40% glucose solution - prevention of local muscle spasm).

· Hyperosmolar coma. It occurs mainly in elderly patients with or without a history of type 2 diabetes and is always associated with severe dehydration. Polyuria and polydipsia are often seen lasting days to weeks before the onset of the syndrome. Elderly people are predisposed to hyperosmolar coma, as they are more likely to have a violation of the perception of thirst. Another difficult problem - altered kidney function (common in the elderly) - interferes with the clearance of excess glucose in the urine. Both factors contribute to dehydration and marked hyperglycemia. The absence of metabolic acidosis is due to the presence of circulating insulin and/or lower levels of contra-insulin hormones. These two factors inhibit lipolysis and ketone production. Hyperglycemia already onset leads to glucosuria, osmotic diuresis, hyperosmolarity, hypovolemia, shock, and, if left untreated, death. It is a vital indication for urgent hospitalization. At the prehospital stage, a hypotonic (0.45%) solution of sodium chloride is injected intravenously to normalize osmotic pressure, and with a sharp decrease in blood pressure, mezaton or dopamine is administered. It is also advisable (as in other comas) to carry out oxygen therapy.

Lactic acidotic coma in patients with diabetes mellitus is caused by the accumulation of lactic acid in the blood and more often occurs in patients over 50 years of age against the background of cardiovascular, hepatic and renal insufficiency, reduced oxygen supply to tissues and, as a result, accumulation of lactic acid in tissues. The main reason for the development of lactic acid coma is a sharp shift in the acid-base balance to the acid side; dehydration, as a rule, is not observed with this type of coma. Acidosis causes a violation of microcirculation, the development of vascular collapse. Clinically, clouding of consciousness (from drowsiness to complete loss of consciousness), impaired breathing and the appearance of Kussmaul breathing, a decrease in blood pressure, a very small amount of urine (oliguria) or its complete absence (anuria) are noted. The smell of acetone from the mouth in patients with lactic acid coma usually does not occur, acetone in the urine is not detected. The concentration of glucose in the blood is normal or slightly elevated. It should be remembered that lactic acid coma often develops in patients receiving hypoglycemic drugs from the biguanide group (phenformin, buformin). At the prehospital stage, a 2% soda solution is injected intravenously (with the introduction of saline, acute hemolysis may develop) and oxygen therapy is carried out.

They represent a group of complications, the development of which takes months, and in most cases years of the course of the disease.

Diabetic retinopathy - damage to the retina in the form of microaneurysms, pinpoint and spotted hemorrhages, solid exudates, edema, formation of new vessels. Ends with hemorrhages in the fundus, can lead to retinal detachment. The initial stages of retinopathy are determined in 25% of patients with newly diagnosed type 2 diabetes mellitus. The incidence of retinopathy increases by 8% per year, so that after 8 years from the onset of the disease, retinopathy is already detected in 50% of all patients, and after 20 years in approximately 100% of patients. It is more common in type 2, the degree of its severity correlates with the severity of nephropathy. The main cause of blindness in middle-aged and elderly people.

Diabetic micro- and macroangiopathy - a violation of vascular permeability, an increase in their fragility, a tendency to thrombosis and the development of atherosclerosis (occurs early, mainly small vessels are affected).

Diabetic polyneuropathy - most often in the form of bilateral peripheral neuropathy of the "gloves and stockings" type, starting in the lower parts of the extremities. Loss of pain and temperature sensitivity is the most important factor in the development of neuropathic ulcers and joint dislocations. Symptoms of peripheral neuropathy are numbness, burning sensation, or paresthesias that begin in the distal regions of the limb. Characterized by increased symptoms at night. Loss of sensation leads to easily occurring injuries.

Diabetic nephropathy - kidney damage, first in the form of microalbuminuria (albumin protein excretion in the urine), then proteinuria. Leads to the development of chronic renal failure.

Diabetic arthropathy - joint pain, "crunching", limitation of mobility, a decrease in the amount of synovial fluid and an increase in its viscosity.

Diabetic ophthalmopathy, in addition to retinopathy, includes the early development of cataracts (clouding of the lens).

· Diabetic encephalopathy - mental and mood changes, emotional lability or depression.

Diabetic foot is a lesion of the feet of a patient with diabetes mellitus in the form of purulent-necrotic processes, ulcers and osteoarticular lesions, which occurs against the background of changes in peripheral nerves, blood vessels, skin and soft tissues, bones and joints. It is the main cause of amputation in diabetic patients.

Diabetes has an increased risk of developing psychiatric disorders such as depression, anxiety disorders, and eating disorders.

General practitioners often underestimate the risk of comorbid psychiatric disorders in diabetes, which can lead to severe consequences, especially in young patients.

8. Preventive measures

Diabetes mellitus is primarily a hereditary disease. The identified risk groups make it possible to orient people today, to warn them against a careless and thoughtless attitude towards their health. Diabetes can be both inherited and acquired. The combination of several risk factors increases the likelihood of diabetes: for an obese patient, often suffering from viral infections - influenza, etc., this probability is approximately the same as for people with aggravated heredity. So all people at risk should be vigilant. You should be especially careful about your condition between November and March, because most cases of diabetes occur during this period. The situation is complicated by the fact that during this period your condition can be mistaken for a viral infection.

Primary prevention of diabetes:

In primary prevention, measures are aimed at preventing diabetes mellitus: lifestyle changes and the elimination of risk factors for diabetes, preventive measures only in individuals or in groups with a high risk of developing diabetes in the future. The main NIDDM preventive measures include rational nutrition of the adult population, physical activity, prevention of obesity and its treatment. Foods containing easily digestible carbohydrates (refined sugar, etc.) and foods rich in animal fats should be limited and even completely excluded from the diet. These restrictions apply primarily to persons with an increased risk of the disease: unfavorable heredity for diabetes, obesity, especially when combined with a diabetic heredity, atherosclerosis, hypertension, as well as women with gestational diabetes or impaired glucose tolerance in the past during pregnancy, to women who gave birth to a fetus weighing more than 4500g. or who had a pathological pregnancy with subsequent fetal death.

Unfortunately, the prevention of diabetes mellitus in the full sense of the word does not exist, but immunological diagnostics are being successfully developed, with the help of which it is possible to identify the possibility of developing diabetes mellitus at the earliest stages against the background of still full health.

Secondary prevention of diabetes:

Secondary prevention provides measures aimed at preventing the complications of diabetes mellitus - early control of the disease, preventing its progression.

Tertiary prevention of diabetes:

Diabetes mellitus consists in preventing the aggravation of diabetes mellitus and its wedge manifestations. It is based on maintaining a stable compensation for the disease. It is important that a diabetic patient be active, well adapted in society, understand the main tasks in the treatment of his disease and the prevention of complications.

9. Nursing process in diabetes mellitus

Nursing process is a method of evidence-based and practical actions of a nurse to provide care to patients.

The purpose of this method is to ensure an acceptable quality of life in illness by providing the maximum possible physical, psychosocial and spiritual comfort for the patient, taking into account his culture and spiritual values.

Carrying out the nursing process in patients with diabetes mellitus, the nurse, together with the patient, draws up a plan for nursing interventions, for this she needs to remember the following:

1. During the initial assessment (examination of the patient), it is necessary:

Obtain health information and identify the patient's specific nursing needs and self-care options.

The source of information is:

Conversation with the patient and his relatives;

Disease history;

alcohol abuse;

inadequate nutrition;

Neuro-emotional stress;

Continuing the conversation with the patient, you should ask about the onset of the disease, its causes, the methods of examination that were carried out:

Blood and urine tests.

Turning to an objective examination of patients with diabetes mellitus, it is necessary to pay attention to:

Color and dryness of the skin;

Weight loss or overweight.

1. In nutrition (it is necessary to find out what kind of appetite the patient has, whether he can eat on his own or not; a nutritionist is required about dietary nutrition; also find out if he drinks alcohol and in what quantity);

2. In physiological functions (stool regularity);

3. In sleep and rest (dependence of falling asleep on sleeping pills);

4. In work and rest.

All results of the initial nursing assessment are recorded by the nurse in the "Nursing Assessment Sheet" (see appendix).

2. The next stage in the activity of a nurse is the generalization and analysis of the information received, on the basis of which she draws conclusions.

The latter becomes the problem of the patient and the subject of nursing care.

Thus, the patient's problems arise when there are difficulties in meeting the needs.

Carrying out the nursing process, the nurse identifies the priority problems of the patient:

* Pain in the lower extremities;

* Decrease in working capacity;

* Dry skin;

3. Nursing care plan.

When developing a care plan with the patient and relatives, the nurse must be able to identify priority problems in each individual case, set specific goals and draw up a real care plan with motivation for each step.

4. Implementation of the nursing intervention plan. The nurse follows the planned plan of care.

5. Turning to the assessment of the effectiveness of nursing intervention, it is necessary to take into account the opinion of the patient and his family.

1. Manipulations performed by a nurse.

Carries out thermometry

Checks water balance

Distributes medicines, writes them out in the prescription journal,

Caring for the seriously ill

Prepares patients for various research methods,

Accompanies patients for examinations,

Performs manipulation.

10. Manipulations performed by a nurse

Subcutaneous injection of insulin.

Equipment: disposable insulin syringe with a needle, one additional disposable needle, vials with insulin preparations, sterile trays, a tray for used material, sterile tweezers, 70 ° alcohol or other skin antiseptic, sterile cotton balls (napkins), tweezers (in a stem eye with a disinfectant ), containers with disinfectants for soaking waste material, gloves.

I. Preparation for the procedure

1. Clarify the patient's awareness of the drug and his consent to the injection.

2. Explain the purpose and course of the upcoming procedure.

3. Clarify the presence of an allergic reaction to the drug.

4. Wash and dry your hands.

5. Prepare equipment.

6. Check the name, expiration date of the medicinal product.

7. Remove sterile trays, tweezers from the package.

8. Assemble a disposable insulin syringe.

9. Prepare 5-6 cotton balls, moisten them with skin antiseptic in a patch, leaving 2 balls dry.

10. Using non-sterile tweezers, open the cap covering the rubber stopper on the vial with insulin preparations.

11. Wipe the bottle cap with one cotton ball with an antiseptic and let it dry or wipe the bottle cap with a dry sterile cotton ball (napkin).

12. Discard the used cotton ball in the waste tray.

13. Draw up the drug in the syringe in the right dose, change the needle.

14. Put the syringe in a sterile tray and transport to the ward.

15. Help the patient to take a comfortable position for this injection.

II. Performing a procedure

16. Put on gloves.

17.. Treat the injection site sequentially with 3 cotton swabs (napkins), 2 moistened with a skin antiseptic: first a large area, then directly the injection site, 3 dry.

18.. Displace the air from the syringe into the cap, leaving the drug in the dose strictly prescribed by the doctor, remove the cap, take the skin at the injection site into the fold.

19. Insert the needle at an angle of 45o into the base of the skin fold (2/3 of the length of the needle); hold the cannula of the needle with your index finger.

20.. Move your left hand to the piston and inject the drug. No need to transfer the syringe from hand to hand.

11 Observation #1

Patient Khabarov V.I., aged 26, is being treated in the endocrinology department with a diagnosis of type 1 diabetes mellitus, moderate severity, decompensation. Nursing examination revealed complaints of constant thirst, dry mouth; profuse urination; weakness, itching of the skin, pain in the hands, decreased muscle strength, numbness and chilliness in the legs. Has been suffering from diabetes for about 13 years.

Objectively: the general condition is severe. Body temperature 36.3°C, height 178 cm, weight 72 kg. The skin and mucous membranes are clean, pale, dry. Blush on cheeks. The muscles in the arms are atrophied, muscle strength is reduced. NPV 18 per minute. Pulse 96 per minute. BP 150/100 mmHg Art. Blood sugar: 11 mmol / l. Urinalysis: beats. weight 1026, sugar - 0.8%, daily amount - 4800 ml.

Disturbed needs: to be healthy, excrete, work, eat, drink, communicate, avoid danger.

Patient problems:

Real: dry mouth, constant thirst, copious urination; weakness; itching of the skin, pain in the hands, decreased muscle strength in the hands, numbness and chilliness in the legs.

Potential: risk of developing hypoglycemic and hyperglycemic coma.

Priority: thirst.

Purpose: to reduce thirst.

Rating: lack of thirst.

12. Observation #2

Patient Samoilova E.K., aged 56, was taken in an emergency to the intensive care unit with a diagnosis of pre-coma hyperglycemic coma.

Objectively: the nurse provides the patient with emergency pre-medical care and facilitates emergency hospitalization in the department.

Disturbed needs: to be healthy, to eat, to sleep, to excrete, to work, to communicate, to avoid danger.

Patient problems:

Real: increased thirst, lack of appetite, weakness, decreased ability to work, weight loss, skin itching, smell of acetone from the mouth.

Potential: hyperglycemic coma

Priority: pre-coma

Purpose: to bring the patient out of a pre-coma state

care plan

Evaluation: the patient came out of the precomatose state.

Considering two cases, I realized that in addition to the main specific problems of the patient, the psychological side of the disease is present in them.

In the first case, the patient's priority problem was thirst. By teaching the patient how to follow the diet, I was able to achieve my goal.

In the second case, I observed an emergency in a pre-coma state of hyperglycemic coma. The achievement of the goal was achieved thanks to the timely provision of emergency assistance.

Conclusion

The work of a medical worker has its own characteristics. First of all, it involves the process of human interaction. Ethics is an important part of my future profession. The effect of treating patients largely depends on the attitude of nurses to the patients themselves. Performing the procedure, I remember the commandment of Hippocrates “Do no harm” and do my best to fulfill it. In the conditions of technological progress in medicine and the increasing equipment of hospitals and clinics with new products of medical equipment. The role of invasive methods of diagnostics and treatment will increase. This obliges nurses to scrupulously study existing and newly arriving technical means, master innovative methods of their application, as well as follow the deontological principles of working with patients at different stages of the treatment and diagnostic process.

Working on this term paper helped me to understand the material more deeply and became the next step in improving my skills and knowledge. Despite the difficulties in my work and lack of experience, I try to apply my knowledge and skills in practice, as well as use the nursing process when working with patients.

Bibliography

1) Diabetes mellitus (brief review) (rus.). Library of Dr. Sokolov. Retrieved September 14, 2009. Archived from the original on August 18, 2011.

2) Clinical endocrinology. Guide / N. T. Starkova. -- 3rd ed., revised and expanded. - St. Petersburg: Peter, 2002. - 576 p. -- (Doctor's Companion). -- ISBN 5-272-00314-4.

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Nursing process is a method of evidence-based and practical actions of a nurse to provide care to patients. The purpose of this method is to ensure an acceptable quality of life in illness by providing the maximum possible physical, psychosocial and spiritual comfort for the patient, taking into account his culture and spiritual values. Carrying out the nursing process in patients with diabetes mellitus, the nurse, together with the patient, draws up a plan for nursing interventions, for this she needs to remember the following: and self-help opportunities.

The source of information is:

• - conversation with the patient and his relatives;
• - disease history;
• - survey data. Next, you need to ask the patient and his relatives about the risk factors:
• - Alcohol abuse;
• - Smoking;
• - Inadequate nutrition;
• - Neuro-emotional stress;

Continuing the conversation with the patient, you should ask about the onset of the disease, its causes, the methods of examination that were carried out: Blood and urine tests. Turning to an objective examination of patients with diabetes mellitus, it is necessary to pay attention to:

Color and dryness of the skin;

Weight loss or overweight. 1. In nutrition (it is necessary to find out what kind of appetite the patient has, whether he can eat on his own or not; a nutritionist is required about dietary nutrition; also find out if he drinks alcohol and in what quantity);

• 2. In physiological functions (stool regularity);
• 3. In sleep and rest (dependence of falling asleep on sleeping pills);
• 4. In work and rest. All results of the primary nursing assessment are recorded by the nurse on the Nursing Assessment Sheet. The next step in the activities of a nurse is the synthesis and analysis of the information received, on the basis of which she draws conclusions. The latter becomes the problem of the patient and the subject of nursing care. Thus, the patient's problems arise when there are difficulties in meeting the needs. Carrying out the nursing process, the nurse identifies the priority problems of the patient: Pain in the lower extremities;

Decrease in working capacity;

Dry skin;

Nursing plan. When developing a care plan with the patient and relatives, the nurse must be able to identify priority problems in each individual case, set specific goals and draw up a real care plan with motivation for each step.

• 4. Implementation of the nursing intervention plan. The nurse follows the planned plan of care.
• 5. Turning to the assessment of the effectiveness of nursing intervention, it is necessary to take into account the opinion of the patient and his family.

Manipulations performed by a nurse. conducts thermometry, checks the water balance, distributes medicines, writes them out in the prescription journal, takes care of the seriously ill, prepares patients for various research methods, accompanies patients for research, performs manipulations.

Emergency care for diabetes:

Emergency care for hyperglycemic coma: Accompanied by thirst, weakness, headache.

With an increase in sugar, an injection of insulin should be given. You can do no more than 2 units of insulin at a time. After 2-3 hours, measure sugar, if it has not changed or dropped slightly, then you can pin it up again. This rule protects against a sharp drop in sugar, which is very harmful to the body.

Emergency care for hypoglycemic coma: due to a violation of the diet, increased physical activity or an overdose of insulin in patients with diabetes mellitus.

Mild hypoglycemia is relieved by taking sugar-containing products (honey, jam). In severe cases, 20-40 ml of 40% glucose is immediately injected intravenously. If the patient regained consciousness after the administration of glucose, there is no need for urgent hospitalization.

The patient should be fed the next day (in connection with feeding, the dose of insulin should be reduced by 8-10 units). Recommend a mandatory examination by an endocrinologist or therapist to correct the daily regimen and insulin dose.

Foot care for diabetic foot:

Diabetic foot is a lesion of the skin, large and small vessels, nerves, bones and muscles of the foot. This pathology is caused by the toxic effect of elevated blood sugar levels. All these changes occur in connection with diabetes mellitus, a disease in which there is an increase in blood glucose levels. Glucose levels rise due to a violation of its regulation by the hormone insulin, which is produced by the pancreas.

Causes of diabetic foot syndrome:

The syndrome occurs as a late complication of diabetes mellitus, when a prolonged increase in the amount of glucose in the blood has a detrimental effect on large (macroangiopathy) and small (microangiopathy) vessels, nervous, musculoskeletal tissue. Thus, diabetes affects many organs and systems. In addition, the lower extremities, and especially the feet and ankles, are less well supplied with blood due to their remoteness from the heart. With prolonged action of elevated sugar levels on the nerve endings of the lower extremities, diabetic neuropathy occurs. Neuropathy leads to a decrease in pain sensitivity - while small damage to the skin of the feet is not felt by the patient and heals very slowly. In addition, the legs have a large load when walking, which interferes with rapid healing.

Types of diabetic feet

There are three forms of the syndrome:

• 1. Neuropathic form
• 2. Ischemic form
• 3. Mixed form

In the neuropathic form, damage to the nervous tissue predominates, in the ischemic form - a violation of blood flow. With a mixed form, there are manifestations of both neuropathic and ischemic forms.

First of all, patients are concerned about pain in the final sections of the feet, which can increase at rest and weaken with movement. Other manifestations of damage to the nervous tissue are also characteristic - numbness, burning or cooling of the feet, paresthesia (crawling, tingling). Deep tissue damage that develops as a result of poor blood supply is represented by poorly healing ulcers, infectious lesions, and gangrene.

Treatment for diabetic foot:

In the treatment, antimicrobial agents are used that do not have tanning properties, such as chlorhexidine, dioxidine, etc. Alcohol, iodine, greenery and potassium permanganate are contraindicated, as they can slow down healing due to tanning properties. It is also important to use modern dressings that do not stick to the wound, unlike the widespread gauze. It is necessary to treat wounds, remove non-viable tissues regularly, this should be done by a doctor or nurse, most often once every 3-15 days. An important role is also played by the protection of the ulcer from the load when walking. For this purpose, special unloading devices are used (half shoe, unloading boot).

Foot care for diabetics:

• 1. Consult a doctor if even a slight inflammation occurs. Even a small inflammation can lead to serious consequences.
• 2. Wash your feet daily, wipe gently without rubbing. We must not forget about the interdigital spaces - they must also be thoroughly washed and dried.
• 3. Examine your feet every day for cuts, scrapes, blisters, cracks, and other lesions through which infection can enter. The soles can be examined with a mirror. In case of poor eyesight, it is better to ask one of the family members to do this.
• 4. Do not expose your feet to very low or very high temperatures. If your feet are cold, it is better to wear socks, do not use heating pads. The water in the bathroom must first be checked by hand and make sure that it is not too hot.
• 5. Inspect shoes daily to prevent blisters and other damage caused by foreign objects in shoes, wrinkled insole, torn lining, etc.
• 6. Change socks or stockings every day, wear only the right size, avoid tight elastic bands and darned socks.
• 7. Shoes should be as comfortable as possible, sit well on the foot, you can not buy shoes that need to be broken in. With a significant deformity of the feet, specially made orthopedic shoes will be required. Street shoes should not be worn barefoot, sandals or sandals, in which the strap passes between the fingers, are contraindicated. Do not walk barefoot, especially on hot surfaces.
• 8. In case of injuries, iodine, alcohol, "potassium permanganate", "brilliant green" are contraindicated - they have tanning properties. It is better to treat abrasions, cuts with special means - miramistin, chlorhexidine, dioxidine, in extreme cases, with a 3% hydrogen peroxide solution and apply a sterile bandage.
• 9. Do not injure the skin of the legs. Do not use preparations and chemicals that soften corns, remove corns with a razor, scalpel and other cutting instruments. It is better to use a pumice stone or foot files.
• 10. Trim nails only straight, without rounding the corners. Do not cut thickened nails, but file them. If the vision is poor, it is better to enlist the help of family members.
• 11. If the skin is dry, the legs should be lubricated daily with a greasy cream (containing sea buckthorn, peach oil), but the interdigital spaces should not be lubricated. You can also use creams containing urea (Balzamed, Callusan, etc.)
• 12. Stop smoking, smoking can increase the risk of amputation by 2.5 times.

In order to monitor blood sugar levels, patients keep self-monitoring diaries. A diabetic self-control diary is necessary for type 1 and type 2 diabetes, as it allows you to control the sugar level during the day, the dosage of insulin or tablets, as well as the number of bread units eaten. In addition, if you download, fill out and provide your doctor with a diabetic self-control diary, you will be able to more accurately adjust the methods of treating diabetes. The diary is a spreadsheet designed to track data for one week. To analyze and correct the treatment of diabetes, you need to download several sheets and fasten them together. (Appendix 6. Table 2)

Preparing the patient for research:

Taking urine for sugar from the daily amount

Target. Determination of the average amount of sugar in the daily volume of urine.

Indications. Suspicion of diabetes mellitus; violation of the functions of the liver, pancreas, thyroid gland, metabolism.

Equipment. Bank capacity Evil direction; pot with direction; a jar with a capacity of 200 ml with a referral to a biochemical laboratory; glass or plastic stick; a list of fluids drunk; volumetric flask.

Technique for taking urine for sugar from the daily amount:

• 1. The night before, the patient is warned about the upcoming study. He is told that tomorrow morning at 6.00 he needs to urinate into the toilet, then go to the post to the nurse for weighing. During the day, the patient, after urinating in a signed pot, needs to pour urine into a three-liter jar. The last urination in the jar must be done at 6.00 the next day and again go to the nurse for weighing. In addition to collecting urine, the patient needs to keep a record of the liquid drunk, as well as liquid food, fruits and vegetables.
• 2. On the morning of the next day after the patient's last urination in a jar, the nurse must mix all the urine in a three-liter jar, measure its amount, pour 200 ml into the prepared jar with a direction, and send it to the laboratory.
• 3. Data on the amount of urine excreted (daily diuresis), the fluid drunk and the patient's body weight are noted in the temperature sheet.
• 4. The result of the study is glued into the medical history.

Notes. Indicators of sugar in the urine (glucosuria) largely depend on the correct collection of the daily amount of urine. Knowing the daily diuresis is necessary to determine the daily loss of sugar in the urine. If the patient is elderly or weakened, the nurse keeps a record of the drunk liquid.

Preparation for a glucose tolerance study:

Glucose tolerance test is a laboratory test that is used to detect diabetes mellitus and pre-diabetic condition.

General rules for preparing for research:

When donating blood for glucose (in addition to the basic requirements for preparing for tests), you can not brush your teeth and chew gum, drink tea / coffee (even unsweetened). A morning cup of coffee will drastically change your glucose levels. Contraceptives, diuretics and other medications also have an effect.

• 1. For most studies, it is recommended to donate blood in the morning, between 8 a.m. and 11 a.m., on an empty stomach (at least 8 hours should elapse between the last meal and blood sampling, you can drink water as usual), on the eve of the study, a light dinner with a restriction eating fatty foods. For infection tests and emergency investigations, it is acceptable to donate blood 4-6 hours after the last meal.
• 3. On the eve of the study (within 24 hours), exclude alcohol, intense physical activity, taking medications (as agreed with the doctor).
• 4. 1-2 hours before donating blood, refrain from smoking, do not drink juice, tea, coffee, you can drink non-carbonated water. Eliminate physical stress (running, fast climbing stairs), emotional arousal. It is recommended to rest and calm down 15 minutes before donating blood.
• 5. You should not donate blood for laboratory testing immediately after physiotherapy procedures, instrumental examinations, X-ray and ultrasound examinations, massage and other medical procedures.
• 6. When monitoring laboratory parameters in dynamics, it is recommended to conduct repeated studies under the same conditions - in the same laboratory, donate blood at the same time of day, etc.
• 7. Blood for research should be donated before the start of taking medications or not earlier than 10-14 days after their cancellation. To evaluate the control of the effectiveness of treatment with any drugs, it is necessary to conduct a study 7-14 days after the last dose of the drug.

If you are taking medication, be sure to tell your doctor about it.

ATTENTION! Special rules for preparing for a number of tests: strictly on an empty stomach, after 12-14 hours of fasting, you should donate blood for gastrin-17, lipid profile (total cholesterol, HDL cholesterol, LDL cholesterol, VLDL cholesterol, triglycerides, lipoprotein (a), apolipo-proten A1, apolipoprotein B) glucose tolerance test is performed in the morning on an empty stomach after 12-16 hours of fasting.

Insulin storage:

Insulin preparations, when properly stored, fully retain their properties until the end of the expiration date indicated on the vial. An unopened bottle is best stored in the dark at a temperature of +2 to +8 C, preferably in a refrigerator on the door or in its lower compartment, but not in the freezer. Frozen insulin should not be used!

In the absence of a refrigerator, for example in a village, it is proposed to store insulin in a cool cellar and even in a well, hanging it in a plastic bag over the water itself. But you should not worry if insulin is not in the refrigerator, cellar or well, since at room temperature (+18 - +20 C) it can be stored for a long time without losing activity - until the expiration date, and in an open vial - up to 1 month. On the other hand, when traveling in summer in hot climates, it is advisable to store insulin in a thermos with a wide opening, which should be cooled 1-2 times a day with cold water. You can simply wrap the vial of insulin with a damp cloth periodically wetted with water.

Of course, insulin should not be left near radiators or stoves. Insulin should never be stored in direct sunlight, otherwise its activity will decrease tenfold.

• · it was accidentally frozen;
• it has changed its color (the action of sunlight gives insulin a yellow-brown hue);
• flakes and suspended particles appeared in short-acting insulin, the solution is cloudy or has a precipitate;
• Suspension of insulin, when stirred, does not form a homogeneous (white or whitish) mixture, lumps or fibers remain in it.

Note that only fast-acting, ultra-short-acting, and short-acting insulins, as well as the new long-acting insulin glargine, should be transparent.

The patient should always remember that an unexplained increase in blood glucose levels may be associated with a possible decrease in the activity of the insulin used.

Ministry of Health of the DPR

Ministry of Education and Science of the DPR

State Educational Institution "Donetsk Medical College"

METHODOLOGICAL DEVELOPMENT OF PRACTICAL LESSON

"NURSING PROCESS IN DIABETES MELLITUS"

PM. 02 MDK.02.01 "Nursing care for diseases in therapy"

Course: III

Specialty: Nursing

Time: 4 hours

Donetsk 2017

Organization - developer:

Donetsk Medical College

DEVELOPER:

E.A. KHADYKINA - Head of educational and industrial practice of DMK, teacher-methodologist of the highest qualification category of Donetsk Medical College

REVIEWER:

V.S. MALINOVSKAYA - Chairman of the methodological commission for professional and practical training of the therapeutic cycle, teacher-methodologist of the highest qualification category of the Donetsk Basic Medical College

Discussed and approved at a meeting of the methodological commission for professional and practical training of disciplines of the therapeutic cycle

Minutes No. _______ dated ________________ 2017

Chairman of the Commission _____________________ V.S. Malinovskaya

NAME

Motivation for studying the topic

Lesson objectives

Integration links

Equipment

Stages of the lesson

Bibliography

Lesson progress

Appendix No. 1 (Instructions for a practical lesson)

Appendix No. 2 (Control questions for a written survey)

Annex No. 3 (Standards for written questions)

Annex No. 4 (Situational tasks)

Annex No. 5 (Standards for situational tasks)

Appendix No. 6 (Test tasks - final control)

Annex No. 7 (Samples of answers to test tasks)

Annex No. 8 (Evaluation criteria)

2. MOTIVATION FOR STUDYING THE TOPIC:

Diabetes mellitus is the most common endocrine pathology among people of different sex and age.even withearly childhood. Among endocrine diseases, diabetes mellitus ranks firston frequencies e- 100 persons per 100 thousand. Diabetes mellitus is a serious disease with a high risk of complications leading to disability and premature death of the patient.

Therefore, the proposed topic is of great importance in the practice of a nurse and requires her knowledge and skills in the early detection of this disease. In addition to identifying complaints and the main manifestations of diabetes mellitus, the nurse should be able to carry out the nursing process in this disease, recognize the symptoms of complications, provide the necessary first aid, educate the patient and his caregivers in self- and mutual care, and prevent diabetes mellitus.

3. OBJECTIVES OF THE LESSON:

Learning goals:

• to form students' knowledge of the definition, causes, clinical manifestations,

risk factors for diabetes;

deepen students' knowledge of the treatment and prevention of diabetes;

develop professional skills in caring for patients with diabetes mellitus.

Know:

Be able to:

U. 3. Prepare patients for laboratory and functional examination methods.

U. 7. To teach the patient and his surrounding self- and mutual care, the rules of rational nutrition, physical activity.

Contribute to the formation of the relevant PC (2.1 - 2.2, 2.4-2.6) and OK (2-3,4,8,12).

Present information in a way that is understandable to the patient, explain to him the essence of the intervention.

Carry out medical and diagnostic interventions, interacting with participants in the treatment process.

Apply medications in accordance with the rules for their use.

Comply with the rules for the use of equipment, equipment and medical products in the course of the treatment and diagnostic process.

Maintain approved medical records.

Organize their own activities, choose standard methods and methods for performing professional tasks, evaluate their performance and quality.

Make decisions in standard and non-standard situations and bear responsibility for them.

To search for and use the information necessary for the effective implementation of professional tasks, professional and personal development.

Independently determine the tasks of professional and personal development, engage in self-education, consciously plan and implement advanced training.

Organize the workplace in compliance with the requirements of labor protection, industrial sanitation, infectious and fire safety.

Educational goals:

promote moral, aesthetic, spiritual education;

to form a professional outlook and a common culture;

to achieve awareness in the right choice of profession;

to focus students' attention on the need to comply with the rules of ethics and deontology in the nursing process;

to cultivate altruism, a humane attitude towards patients, a sense of responsibility for the results of their work.

to educate students in the most important personal and professional qualities of a medical worker:

be aware of the responsibility for the life of the patient;

be able to analyze their behavior;

educate the ability to work according to standards, algorithms.

to form a sense of responsibility for the timely and high-quality implementation of measures for the prevention of nosocomial infections.

broaden horizons, enrich the erudition of students, maintain interest in the discipline being studied.

Development goals:

to promote the development of students' understanding of the essence and social significance of their future profession, sustainable interest in it;

develop creative thinking, professional speech, cognitive activity.

4. INTEGRATION RELATIONS (INTER- AND INTERMODULAR, INTRA-DISCIPLINARY, RELATIONS WITH OTHER EDUCATIONAL DISCIPLINES):

Know

Theory and practice of nursing

Basic ethical principles of the philosophy of nursing.

Levels, elements of effective communication. Comfort zones.

Conditions that promote and hinder effective communication between a nurse and a patient. Training in nursing

Rules for filling out medical documentation. nursing pedagogy

Safe environment for staff and patient

Infection safety

Safe environment for patient and staff

personal hygiene

Technology for the provision of medical services

Nursing technologies for the provision of medical services. Be proficient in handling patient care

Anatomy and Physiology

Anatomy and physiology of the pancreas. Functions of pancreatic hormones.

Pharmacology

The main groups of medicines, write prescriptions, analyze the therapeutic and side effects of drugs.

Fundamentals of Pathology

Pathological changes in the pancreas.

Basics of the Latin language with medical terminology

Medical terms and rules of application in practice

Culture of speech in professional communication

Norms of the literary language and rules of application in practice

Legal support of professional activity

Regulations

Propaedeutics and diagnostics of internal diseases

The concept of the disease, the rules for collecting anamnesis, the main causes and conditions for the development of diseases, the scheme for examining the patient.

5. EQUIPMENT :

Equipment:

• phantoms, dummies;

  phonendoscopes, tonometers, objects care;

  methodological guide for students;

  presentation, educational film on diabetes carediabetes.

  equipment, devices, tools necessary for the diagnosis, treatment, care and rehabilitation of patients with diabetesdiabetes.

Technical means learning:

• a computer;

  multimedia projector;

  blackboard (chalk/marker);

  screen.

Visual aids : table "Diabetes mellitus"; case histories, sheets of medical appointments. Didactic material: temperature sheets, forms with blood and urine tests, glycemic, glucosuric indicators; tests, situational tasks, illustrations.

LESSON STAGES:

Stage name

Stage time

Organizational stage

Final control

The final stage. Summing up the lesson

Assignment for independent work

BIBLIOGRAPHY:

Main:

1. Makolkin, V.I. Nursing in Therapy: A Textbook.- M.: LLC "Medical Information Agency", 2008.- 544p.

   Obukhovets, T.P. Nursing in therapy with a course of primary care: Workshop.- Rostov on / D .: Phoenix, 2011.- 416

Additional:

Nikitin Yu.P., Chernyshev.V.M Guidelines for paramedical workers GEOTAR-Media, Moscow, 2007.

Oganov R.G. Guidelines for medical prevention GEOTAR-Media, Moscow, 2007.

Frolkis, L.S. Diagnostic studies in diseases of the circulatory organs // Handbook of paramedics and midwives. - 2008. - No. 7. - P.11-14.

Fedyukovich, N.I. Internal illnesses. / N.I. Fedyukovich - Rostov n / a: Phoenix, 2010.- 573p.

STUDY PROCEDURE:

p/n

Stage name

Learning objectives in learning levels

Stage description. Methods of control and training.

Methodological support materials (control, visibility, algorithms, instructions)

Stage time

Organizing time

Absent and the appearance of students and the audience are noted, the topic, motivation, goals of the lesson are reported, the plan for the lesson is reported. Labor protection briefing.

Checking the initial level of knowledge

a) checking the initial level of knowledge.

B) verification of extracurricular independent work of students.

C) summing up the results of control: The teacher draws attention to the mistakes made, makes adjustments to the answers, notes the best students and gives recommendations, explanations to those who made mistakes.

Application №2

(Test questions)

Application No. 3

(Sample answers to control questions)

Workbooks: glossary of medical terms, schemes of indicative actions for diseases of the pancreas, multimedia presentations.

Main stage. Practical part

A. Independent work of students: solving problem-situational problems. The teacher monitors the progress of independent work, where necessary, makes specific recommendations to students, answers their questions.

Preparing students for independent work: conducting briefings on completing assignments, teaching the skills to work with a book, regulatory, legal, medical documentation. Conducting briefing and distribution of individual tasks.

practical skills.

Summing up the results of independent work, analysis of the solution of problem-situational tasks.

Application No. 1

(Instruction for a practical lesson)

Tables for diseases of the pancreas

Application No. 4

(situational tasks)

Questions on a self-studied topic

Practical skills algorithms.

Final control

Final control

Application No. 6

(Test tasks - final control)

Application No. 7

(Standards of answers to test tasks)

Summing up the lesson

The teacher briefly analyzes the lesson and gives a critical assessment of each of its stages, draws attention to good results and mistakes made, highlights the best work and points out the lag, insufficient preparation for the lesson, notes the progress in the learning activities of students.

Analysis of the implementation of practical skills and their results. Grading

Application No. 8

(Rating criteria)

Independent work (homework, extracurricular work)

Attachment 1

INSTRUCTIONS FOR PRACTICAL LESSON

PM. 02 MDK.02.01. "Nursing care for diseases in therapy"

Topic: "Nursing process in diabetes"

Know:

H .1. Definition, etiology, pathogenesis, idea of ​​classification.

H.2. The main clinical symptoms of diabetes mellitus.

Z.3. Nursing process in diabetes mellitus (methods for diagnosing problems

patient; organization and provision of nursing care).

Z. 4. The participation of a nurse in the diagnostic process.

Z. 5. Principles of treatment, features of insulin therapy, routes of drug administration

H. 6. The concept of complications of diabetes.

H. 7 Features of care and guardianship of patients with diabetes mellitus.

Be able to:

T. 1. Perform a nursing examination for diabetes mellitus.

T. 2. Establish nursing diagnoses, solve actual and potential problems of the patient.

U. 3. Prepare patients for laboratory and functional examination methods (taking blood for glucose, conducting a glucose tolerance test, taking a urine test for glucose, determining urine sugar using Glucotest, determining urine acetone using an express method).

U. 4. Monitor the patient in dieting for diabetes.

U. 5. Conduct the administration of insulin to patients with diabetes mellitus.

U. 6. Provide emergency first aid for hypo- and hyperglycemic coma.

U. 7. To teach the patient and his surrounding self- and mutual care, the rules of rational

nutrition, physical activity.

U. 8. Maintain nursing records.

Planned repetition of basic skills:

Insulin administration technique (dose calculation, technique, administration rules).

Performing all types of injections.

Intravenous drip injection technique.

Measurement of blood pressure, graphical representation in the temperature sheet.

Determination of the pulse, registration.

Counting the respiratory rate.

Determination of daily diuresis.

Prepare abstract message:

"Nutrition for Diabetes"

"Modern technologies for insulin administration: insulin pump, implantable insulin pump, smart pen caps"

Homework : Learn

1. pp 228 - 238 V.G. Lychev, V.K. Karmanov Nursing in therapy. With a course of primary health care: textbook.- 2nd ed..- M.: FORUM: INFRA-M, 2013.- 544 p.

Annex 2

Control questions for an individual written survey

Define diabetes mellitus, name the main causes and contributing factors of this disease.

Classification of diabetes?

Name the complaints and main symptoms of diabetes mellitus.

Name the main laboratory parameters for diabetes mellitus.

What organs and systems are affected in diabetes mellitus?

What are the clinical manifestations of skin lesions?

What is diabetic angiopathy?

List the complications of diabetes.

Describe the diet for diabetes.

List the principles of diabetes management.

Name the groups of insulin preparations, what are the features of insulin therapy?

Annex 3

Standards

to control questions to an individual written survey

1 . Define diabetes mellitus, name the main causes and contributing factors of this disease.

Diabetes mellitus is an endocrine disease caused by an absolute or relative deficiency of insulin in the body, which leads to a violation of all types of metabolism.

Causes: heredity, viral infections, psychotrauma, inflammation and tumors of the burn, autoimmune lesions, removal of the pancreas, systematic overeating, birth defects in insulin formation, the influence of insulin antagonist hormones.

Contributing factors:Obesity, unbalanced diet, sedentary lifestyle, physical inactivity, psycho-emotional overload, stressful situations, chronic gastritis, cholecystitis

2. Classification of diabetes
1. Downstream: labile, stable
2. By severity: light, medium, severe
3. By etiology: primary, secondary

3 .Name the complaints and main symptoms of diabetes mellitus

Complaints: dry mouth, weight loss, itching of the skin in the genital area, general weakness, decreased performance, decreased vision, pain in the heart, legs, sleep disturbance, irritability, depression, dryness and peeling of the skin,

Symptoms: increased appetite, thirst, frequent urination, hyperglycemia, glucosuria, rubeosis, xanthosis.

4. What are the main laboratory parameters for diabetes

Hyperglycemia more than 6.6 mmol / l;

Glycolized Hb ≥ 6.5%

Glucosuria;

Ketonuria;

High density of urine.

5. What organs and systems are affected in diabetes mellitus?

In diabetes mellitus, all organs and systems are affected - the cardiovascular, digestive, nervous systems, respiratory organs, eyes, kidneys, skin.

6. What are the clinical manifestations of skin lesions in diabetes mellitus?
The skin is dry, rough, easily flaky, scratching, frequent boils, eczema, redness in the chin, superciliary ridges (rubeosis), yellowish coloration of the palms and feet (xanthosis), lipodystrophy.

7. What is diabetic angiopathy?

Against the background of progressive diabetes mellitus, multiple vascular lesions develop.

8. List the complications of diabetes.

All complications that occur in patients with diabetes can be divided into

- sharp : coma (the most formidable complications)

- chronic:

damage to the vascular system (angiopathy) damage to the nervous system (due to chronic encephalopathy with frequent hyper- and hypoglycemic conditions)

damage to other organs

Describe the diet for diabetes .

food should be fractional, 5-6 times a day

refined carbohydrates (sugar, cookies, sugary foods) are excluded

limited animal fats

grapes, bananas, sweet pears, plums are excluded

additional consumption of fat-free foods (cottage cheese, oatmeal, vegetables,

fruit)

alcohol is excluded.

Atwhen choosing products containing carbohydrates, various groups of carbohydrates are distinguished, taking into account theirglycemic index .

List the principles of diabetes management.

Basic treatment :

Oral hypoglycemic drugs:sulfa drugs (bucarban, oranil, diabeton, maninil, butamid),biguanides (glibutide, adebit, etc.). insulin therapy.

Symptomatic treatment : lipotropic drugs (reducing the level of fats in the blood), angioprotective drugs (improving the condition of blood vessels), vasodilators, B vitamins and especially vit. E, C, potassium preparations (asparkam, panangin), herbal medicine to reduce blood sugar (bilberry leaves, strawberries, burdock beans, etc.).

Name the groups of insulin preparations, what are the features of insulin therapy?

international name

Tradename

Action

Start

Peak

Duration

Ultrashort action. (insulin analogues)

Insulin lispro

Humalog

b/p 5-15 min

b/c 1-2 hours

4-5 hours

insulin aspart

Novorapid

insulin glulisine

Apidra

short action

Insulin soluble human genetically engineered

Actrapid NM

Humulin Regular

Biosulin R

Gensulin R

Rosinsulin R

Humodar R

b/w 20-30 min

b/w 2-4 h.

5-6 hours

Moderate duration of action (stir well before administration)

Isophane - human insulin genetically engineered

Protafan NM

Humulin NPH

Insuran NPH

Biosulin N

Rosinsulin R

Humodar B

b/w 2 hours

h/h 6-10 h.

12-16 hours

Long-acting (human insulin analogues)

insulin glargine

lantus

b/w 1-2 hours

not expressed

up to 24 hours

insulin detemir

Levemir

Mixtures of short-acting and NPH insulins

Insulin biphasic human genetically engineered

Humulin MZ

Biosulin 30/70

Humodar B

Same as ultrashort acting insulin and NPH insulins, i.e. mixes act separately

Blends of ultrashort insulin analogs and long-acting insulin analogs

biphasic insulin lispro

Humalog Mix 25

Same as ultrashort-acting insulin analogs and PNH insulins, i.e. act separately in a mixture

Humalog Mix 50

Biphasic insulin aspart

NovoMix 50

NovoMix 70

Appendix 4

Situational tasks

Task #1

Patient K., aged 56, complains of thirst, dry mouth, increased weakness, frequent urination. Sick for about a year. I have lost a lot of weight lately. Objectively: the patient is overweight (height 158 ​​cm, weight 86 kg). The skin is dry, there is a blush on the cheeks and chin. Brittle nails, sparse hair. Over the past year, she has lost 5 teeth, her eyesight has deteriorated sharply. In the lungs - vesicular breathing. The borders of the heart are expanded to the left, the heart sounds are muffled, rhythmic. Pulse - 78 beats. for 1 minute, blood pressure - 150/85 mm Hg. Art. The abdomen is soft, slightly painful in the right hypochondrium, the lower edge of the liver protrudes by 2 cm. The spleen is not enlarged.

Identify the patient's concerns and develop a care plan.

Task #2

Patient G., 49 years old, suffers from diabetes mellitus, is treated on an outpatient basis with insulin. At noon, I entered the usual dose of insulin (16 IU) and went shopping. Returning home, she felt a sudden strong feeling of hunger, anxiety, excessive sweating, trembling hands. The patient lost consciousness. The skin is pale, moist. Tonic and clonic convulsions. Pulse of weak filling. BP could not be measured due to seizures. Heart sounds are muffled, tachycardia.

What complication developed in the patient?

Task #3

The paramedic went to see patient P., aged 52. According to relatives, she is ill
diabetic, receiving insulin. After severe mental trauma 3 days
back became lethargic, drank a lot and slept, due to severe weakness, she was forced to
be in bed. In the morning, the relatives who came to visit the sick woman did not
were able to wake her up. On examination: the patient is unconscious, breathing is noisy, slow, the smell of acetone from the mouth. The face is hyperemic, the eyeballs are soft, the pupils are constricted. Tongue dry, bright red. Pulse - 96 beats for 1 minute, weak filling. BP - 90/60 mm Hg. Heart sounds are muffled.

Make a plan for emergency care, further tactics.

Annex 5

Standards for situational tasks

TASK #1

1. What diagnosis can be suspected? Diabetes

2. Make a plan for laboratory and instrumental examination.

Determining the level of sugar in the blood;

Determination of the level of glycosylated hemoglobin;

Test for glucose tolerance;

Determining the level of sugar in the urine;

Determination of specific gravity in urine (according to Zimnitsky);

Determination of the level of ketone bodies in the blood and urine;

Abdominal ultrasound.

3. Identify the patient's problems: thirst; dry mouth; frequent urination;

significant weight loss; loss of 5 teeth;

4. Make a care plan:

1. Convince the patient of the need to follow the diet prescribed by the doctor;

3. Conduct a conversation about the causes, nature of the disease and its complications;

4. Inform the patient about insulin therapy;

5. Control:
- the condition of the skin;
- body weight;
- pulse and blood pressure;
- pulse on the artery of the rear of the foot;
- adherence to diet and diet; transmission to the patient from his relatives;
- recommend constant monitoring of glucose in the blood and urine.

TASK #2

1. What complication has developed in the patient? Hypoglycemic coma

2. Make a plan for emergency care, further tactics.

Urgent care:

If in a state of precoma: give sweet tea, candy or sweet coffee;

If the state of coma: in / in a stream of 50 ml of 40% glucose, if you do not come to, repeat

after 10-15 minutes;

In / in a stream slowly Prednisolone 30-60 mg;

0.1% Adrenaline 1 ml s / c;

If not effective: intravenous drip of 5% glucose 500 ml or more until glucosuria appears.

TASK #3

1. What complication has developed in the patient? Hyperglycemic coma

2. Make a plan for emergency care, further tactics.

Urgent care:

In / in drip 0.9% NaCl solution per day from 6 to 10 liters.

IV bolus 10-20 IU of short insulin;

Potassium preparations: Asparkam;

4% solution of soda (to eliminate acidosis);

Drugs that increase blood pressure (Cardiamin, Caffeine)

Plentiful drink

Bed rest

Appendix 6

Test tasks

Which disease is characterized by a symptom complex: thirst, polyuria, glucosuria, hyperglycemia:

A Diabetes insipidus

B Diabetes mellitus

C Thyrotoxicosis

D Myxedema

E Pheochromocytoma

Diet number 9 is prescribed to patients who:

A Chronic gastritis

B Pyelonephritis

C Chronic hepatitis

D Acute gastritis

E Diabetes mellitus

The patient was prescribed 36 units of insulin. How many ml of insulin will you draw in a 1 ml syringe?

Specify on the basis of what research it is possible to make a diagnosis - diabetes mellitus

A Cystoscopy

B Bronchoscopy

D Laboratory

E Gastroscopy

A patient came to you with the following symptoms: polydipsia, polyuria, polyphagia, hyperglycemia, glucosuria. What disease do you suspect?

A Diffuse toxic goiter

B Renal failure

C Hypothyroidism

D Diabetes mellitus

E Thyroiditis

Specify the most important factor in the occurrence of type 1 diabetes mellitus:

A Excessive food intake

B Hereditary deficiency of pancreatic beta cells

C Congenital thyroid deficiency

D Sedentary lifestyle

E Negative emotions that cause stress.

Polydipsia, polyuria, polyphagia, hyperglycemia and glucosuria are the clinical symptoms of the disease:

A Hypothyroidism

B Diffuse toxic goiter

C Acute kidney injury

D Chronic kidney injury

E Diabetes mellitus

In patient K., 18 years old, who suffers from diabetes, the nurse revealed the following problems: hunger, body trembling, convulsions, dizziness. This testifies to:

A hypoglycemia

B hyperglycemia

C hypertension

D hyperthermia

E hypothermia

You work as a ward nurse. Patient M., 32 years old, developed a hypoglycemic coma. Which of the following drugs will you inject first?

A insulin

C glucose

D rheopolyglucin

E corglicon

What diet for Pevzner is prescribed for patients with diabetes mellitus:

A 67-year-old patient with diabetes mellitus has drowsiness, nausea, thirst, smell of acetone from the mouth, and abdominal pain. What should a nurse prepare for emergency care?

A Glucose

B Insulin

C Cordiamin

D Platifilin

E Mezaton

The patient is 20 years old, has a tendency to furunculosis, thirst, polyuria, itching and dry skin. What blood test should be ordered to establish the diagnosis?

A Complete blood count

B Blood glucose test

C Blood test for bilirubin

D Blood test cholesterol

E Urea blood test

The nurse was called to the workshop to see a man who suddenly lost consciousness at the workplace. Colleagues said that he was sick with some kind of disease, and therefore he was on a diet. On examination: the skin is moist, there are traces of injections on the front surface of the thighs. Eyeballs are hard, PS - 90 beats. for 1 min., low voltage, blood pressure 80/60 mm Hg. What about the sick?

A Diabetic coma

B Uremic coma

C Hypoglycemic coma

D Fainting

E Collapse

A 49-year-old patient was taken to the hospital unconscious. The skin is dry, the eyeballs are soft, noisy deep breathing of Kussmaul is noted, the smell of acetone from the mouth is felt. What pathological condition has developed in the patient?

A hepatic coma

B uremic coma

C dizziness

D hypoglycemic coma

E hyperglycemic coma

A 38-year-old patient complains of weakness, thirst, frequent urination, dry skin, decreased vision. She has been ill for about 2 years, during which she has significantly lost weight, lost 6 teeth. The skin is dry, there is a blush on the cheeks and chin. Nails are flat, brittle, hair is sparse. What examination is the most informative for the patient to confirm the diagnosis?

A blood sugar test

B complete blood count

C blood test for cholesterol

D urinalysis

E urinalysis according to Nechiporenko

A nurse from the endocrinology department was called to see a 50-year-old diabetic patient who is receiving insulin. The patient is unconscious, in serious condition, convulsive twitching of the muscles. The skin is pale, moist. What complication would the nurse think of?

A Collapse

B Hyperglycemic coma

C Uremic coma

D Hypoglycemic coma

E Fainting

Which of the drugs should be used in hypoglycemic coma?

A Dibazol solution

B Glucose solution

C Insulin

D Corglicon solution

E Heparin solution

A 20-year-old patient was taken to the emergency department with hyperglycemic coma. What drug should be prepared for administration?

A 40% glucose solution

B Adrenaline

C 0.9 \% NaCl solution

D Insulin

E Analgin

Symptom complex: polydipsia, polyuria, polyphagia are characteristic problems of a patient who has:

A Diabetes mellitus

B Pyelonephritis

C Hypothyroidism

D Obesity

E Diabetes insipidus

A patient with diabetes mellitus, an insulin-dependent form, being late for work, did not have breakfast after an insulin injection. What complication can arise?

A Hyperglycemic coma

B Hypoglycemic coma

C Lactic acid coma

D Hyperosmolar coma

E Hepatic coma

The nurse found the patient in the ward lying unconscious on the bed. During the examination, it turned out that the skin was pale, very moist, breathing was shallow, blood pressure and pulse were unchanged, muscle tone was increased; eyeballs of normal tone. Suffering from diabetes. Which condition is characterized by these clinical signs?

A Diabetic coma

B Anaphylactic shock

C Hypoglycemic coma

D Cerebral coma

E Hepatic coma.

Patient M., 56 years old, complains of constant thirst, dry mouth, general weakness, frequent urination, visual impairment over the past year. Objectively: the skin is dry. Pulse 80 beats/min, BP -150/80 mm Hg, abdomen is soft, liver near the edge of the costal arch. Blood sugar: 7.8 mmol / l. What disease are we talking about?

A Chronic glomerulonephritis

B Hypertensive disease

C Chronic pyelonephritis

D Diabetes mellitus

E Hypothyroidism

You are a medical ward nurse. A patient with diabetes developed a diabetic coma. Which of the drugs will you prepare for emergency care?

A Intermediate acting insulin

B Short-acting insulin

C Long-acting insulin

D Glucose

E Antihyperglycemic tablets

How should a nurse act if a patient with diabetes mellitus develops a hyperglycemic state:

A. Give IV 40% glucose solution

B. Administer intravenous hypertonic sodium chloride solution

C. Make a hypertonic enema

D. Inject intravenous isotonic sodium chloride solution

E. Give the patient intravenous insulin as prescribed by the doctor

After the introduction of insulin, the patient suddenly developed a feeling of hunger, trembling of the limbs, the skin is moist, the patient is agitated. What complication can you think of?

A Hyperglycemic coma

B Convulsive syndrome

C Hypoglycemic coma

D Collapse

E Pulmonary edema

Patient M., suffering from diabetes mellitus, developed hypoglycemia after an overdose of insulin. What should the nurse do at the first sign of this condition?

A Let the patient eat a piece of sugar, drink warm sweet tea

B Inject insulin

C Administer caffeine IM

D Inject 0.1% adrenaline solution subcutaneously

E Raise the head end of the bed and lower the lower limbs

A 40-year-old man with insulin-dependent diabetes mellitus had a sore throat, after which thirst increased, nausea, vomiting, and drowsiness appeared. Pulse 125 beats/min, BP 80/45 mm Hg. Art. The skin is dry, breathing is noisy. Dry tongue. The smell of acetone from the mouth. What complication of the underlying disease occurred in the patient?

A Ketoacidotic coma

B Hyperosmolar coma

D Hypoglycemic coma

E Hypovolemic coma

A patient with diabetes mellitus developed a hyperketonemic coma. When providing emergency assistance, you must enter:

A glucose

B dibazol

C atropine

D insulin

E magnesium sulfate

You are the school nurse. A pupil of the 6th grade, who suffers from diabetes mellitus, developed weakness, dizziness in the fifth lesson, the child became covered with cold sweat, turned pale. What is the condition of the child?

A Fainting

B Acetonemia

C Hyperglycemia

D Collapse

E Hypoglycemia

The nurse on duty found the patient in a state of unconsciousness, the skin is pale, moist, tonic and clonic convulsions, the pulse is weak filling, blood pressure is reduced. The nurse suspected a hypoglycemic coma in the patient. What drug, according to the doctor's prescription, should be used in the first place?

A 5% glucose solution IV drip

B 40% glucose solution IV slowly

C 10% calcium chloride solution IV slowly

D 0.1% intravenous adrenaline solution slowly

E 50 mg IV hydrocortisone slowly

The patient is 40 years old. Suffering from diabetes. Complains of weakness, hunger, trembling, dizziness, palpitations, sweating. Complaints appeared after exercise. Which of the drugs should be prepared by the nurse?

A 4% sodium bicarbonate solution

B insulin

C 5% glucose solution

D 0.1% adrenaline solution

E 40% glucose solution

A 46-year-old woman, lost consciousness, deep breathing (Kussmaul), smell of acetone. Pulse 120 per minute, BP 80/50 mm Hg. Art. The skin is dry, the eyeballs are soft on palpation, the pupil is constricted. What condition are these symptoms typical for?

A Uremic coma

B Hyperosmolar coma

C Ketoacidotic coma

D Hypoglycemic coma

E Cerebral coma

A 20-year-old patient was delivered to the emergency department, unconscious. A diabetic card was found in his pocket. The skin is pale, turgor is reduced. Breathing is noisy, deep, the smell of acetone from the mouth. Heart rate 105 for 1 min., BP - 90\60 mm Hg. Which of the drugs should be prepared by the nurse in the first place?

A insulin

B 5% glucose solution

C 0.1 \% adrenaline solution

D rheopolyglucin

E 0.9% sodium chloride solution

A 36-year-old patient suffering from diabetes mellitus and receiving insulin was taken to the department in serious condition, unconscious. Convulsive twitching of muscles, pallor and moisture of the skin are noted. Heart rate 98 for 1 minute, blood pressure - 110\ 70 mm Hg. There is no smell of acetone. Which of the drugs should the nurse prepare first?

A glucagon

B insulin

C norepinephrine

D 40% glucose solution

E 5% glucose solution

Specify the drug to be administered to a patient with hypoglycemic coma:

A Plain insulin 20-40 IU IV

B Glucose 40\% 20-40 ml

C Diphenhydramine 1% 1 ml s.c.

D Analgin 50% 2 ml IM

E Vikasol 1\% 2 ml IM

A 48-year-old patient suffers from diabetes and takes insulin. After the introduction of the usual dose of insulin, the patient felt severe hunger, a feeling of trembling in the body, a sharp weakness, the skin was covered with sweat. A few minutes later the patient lost consciousness. Objectively, the skin is moist, PS- 80/min, BP- 150/90 mm Hg, pronounced muscle hypertonicity. Heart sounds are muffled, vesicular breathing in the lungs, the abdomen is soft. What complication arose in the patient?

A Hyperglycemic coma

B Fainting

C Epileptic seizure

D Hypertensive crisis

E Hypoglycemic coma

A 46-year-old patient suffering from diabetes mellitus did not eat after the administration of insulin. The nurse revealed that the patient was trembling, convulsions, severe sweating. What complication can you think of?

A Hypoglycemic coma

B Ketoacidotic coma

C Hypertensive syndrome

D Hypotensive syndrome

E Hyperthermic syndrome

A sign of hypoglycemic coma in a patient with diabetes is:

A Headache

B Dry skin

C Smell of acetone

D Increase in body temperature

E Wet skin

What should be administered to the patient in order to bring him out of the state of hypoglycemic coma?

A 20-40 ml 40% glucose solution IV

B 1 ml 1% solution of promedol s.c.

C 12 units of insulin s.c.

D 400 ml IV neohemodesis

E 5 ml 24% solution of eufillin in / m

Patient K, 40 y.o. 20 minutes after the introduction of 32 units of insulin, there was a general weakness, sweating, tremor of the limbs. This is typical for:

A Ketoacidotic coma

B Hepatic coma

C Conditions of hypoglycemia

D Hyperosmolar coma

E Convulsive syndrome

Appendix 7

Standards for test tasks

Appendix 8

Criteria for evaluating the solution of situational problems

5 (excellent)- the student correctly and fully conducts an initial assessment of the condition, independently identifies the satisfaction of which needs are violated, determines the patient's problems, sets goals and plans nursing interventions with their justification, conducts a current and final assessment.

4 (good)- the student correctly conducts a primary assessment of the state, identifies the satisfaction of which needs is violated, determines the patient's problems, sets goals and plans nursing interventions with their justification, conducts a current and final assessment. Some minor difficulties in the answer are allowed; justification and final assessment is carried out with additional comments of the teacher.

3 (satisfactory)- the student correctly, but incompletely, conducts an initial assessment of the patient's condition. Identification of the satisfaction of what needs is violated, the definition of the patient's problem is possible with leading questions from the teacher. Sets goals and plans nursing interventions without justification, conducts ongoing and final assessments with leading questions from the teacher; Difficulties with a comprehensive assessment of the proposed situation.

2 (unsatisfactory)- incorrect assessment of the situation; incorrectly chosen tactics of action.

Criteria for assessing test items

Grade "5" (excellent) - 90% correct answers

out of 40 tests - 4 wrong answers

Grade "4" (good) - 80% correct answers

out of 40 tests - 8 wrong answers

Grade "3" (satisfactory) - 70% correct answers

out of 40 tests - 12 wrong answers

Grade "2" (unsatisfactory) - 69% of correct answers

out of 40 tests - 13 wrong answers and more